Cervical Insufficiency and Cerclage

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CCRMC OBGYN Prenatal Guideline
Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours.
Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.

Cervical Insufficiency and Cerclage
Criteria for Placement
  1. Prior pregnancy loss(s) or delivery 15-28 weeks with history of significant cervical dilation without labor. Don’t be falsely reassured by long cervix on NT or other first trimester sono
  2. History of indicated cerclage in prior pregnancy
  3. Cervical length < 1.5cm by ultrasound (rescue cerclage indicated)
Be sure to inquire about circumstances of second trimester losses, later SABs, pre-viable deliveries, very preterm deliveries or early PPROM to see if consistent with cervical incompetence during initial prenatal visit. Note cervical length on anatomy scan if prior LEEP.
Criteria for weekly ultrasounds from 16-26 weeks for cervical length instead of elective cerclage
  1. Possible prior loss or early delivery due to cervical insufficiency (circumstances unclear)
  2. Patient prefers monitoring to elective cerclage placement
  3. If cervix < 1.5-2.5 cm and history of possible cervical insufficency recommend urgent cerclage
Logistics of elective placement
  1. Schedule for placement ideally at 14 weeks; ideally post NT ultrasound if desired. Do at least clinic sono to verify dates and viability.
  2. Schedule in OB Attending prenatal or GYN clinic at least a week before cerclage needed—inbasket OB provider to let them know so they can schedule and review chart before visit
Logistics of rescue placement for incidental short or dilated cervix by sono or found on exam
  1. Less than 23 weeks EGA call OB on call and plan immediate transfer to CCRMC
  2. 23 weeks or greater call Perinatology at ABMC or JMH and arrange immediate transfer per their instruction.
Care of cerclage
  1. Patient needs to tell all relevant care providers of cerclage
  2. Pelvic rest suggested for 2 weeks post elective cerclage and for entire pregnancy for rescue cerclage
  3. Serial ultrasound cervical lengths every 2 weeks after placement until 26 weeks
  4. Patient to go urgently to labor and delivery for regular contractions and/or bleeding

Cerclage removal
  1. Removed anytime in labor or if bleeding (patients should always tell providers that they have a cerclage)
  2. Typically removal scheduled on Labor and Delivery by calling 370-5608 for about 37 weeks EGA
  3. May be removed in clinic